Diagnostic tool reliably predicted obstructive sleep apnea
Researchers have validated the use of the Sleep Apnea Clinical Score, according to data published in Mayo Clinic Proceedings.
Michael Grover, DO, of the Department of Family Medicine at the Mayo Clinic, and colleagues found the tool “reliably predicted” obstructive sleep apnea in a family medicine practice.
“Accurate risk prediction for [obstructive sleep apnea] OSA suspects could have a substantial impact on primary care practice,” they wrote. “High-risk patients could safely have intermediate testing, such as overnight oximetry, deferred and have their access to specialty consultation and polysomnography prioritized.”
Grover and colleagues continued, “Low-risk OSA suspects could have any further referral and testing delayed and instead implement lifestyle modifications and simple clinical interventions. For that group, observation for symptom improvement would be reasonable with intermittent re-evaluation of risk in primary care.”
They stated that risk stratification with the Sleep Apnea Clinical Score (SACS) might help in shared decision-making between patients and physicians, and increase patient education and understanding.
The researchers conducted a prospective cohort study of 191 adult family medicine patients without obstructive sleep apnea, previous obstructive sleep apnea testing or life-limiting conditions. Each participant was evaluated using the SACS tool and completed overnight oximetry, sleep medicine consultation and polysomnography.
Obstructive sleep apnea prevalence was similar between the study cohort and the derivation cohort (40% vs. 45%, respectively).
Results showed an SACS score of greater than 15 was 40% sensitive and 90% specific, and had a positive predictive value of 73% and a negative predictive value of 69%.
An SACS score of greater than 15 in the study cohort produced a likelihood ratio of 4.03 with 73% post-test probability for obstructive sleep apnea compared with a likelihood ratio of 5.17 with 78% post-test probability in the derivation cohort.
“Obstructive sleep apnea is a prevalent and under-diagnosed condition,” the researchers wrote. “Treatment of OSA decreases symptoms, improves associated medical conditions, and potentially reduces morbidity and mortality. Primary care practice settings provide many opportunities for risk assessment and stratification. The SACS tool has now been validated for use in these populations. Further studies are needed to facilitate routine implementation and widespread dissemination.” – by Chelsea Frajerman Pardes
Disclosures: The authors report grant support from the Mayo Foundation, as well as support from grant ULI TR0000135 and from the Mayo Clinic Department of Family Medicine.